İntramedüller Çivileme Komplikasyonları – 4: Avasküler Nekroz ve Kıkırdak Hasarı

Mert Gündoğdu

Marmara Ünı̇versı̇tesı̇ Pendı̇k EAH, Ortopedi ve Travmatoloji, İstanbul, Türkiye

Gündoğdu M. İntramedüller Çivilime Komplikasyonları – 4: Avasküler Nekroz ve Kıkırdak Hasarı. Açan AE, Tokyay A, editör. Alt Ekstremitede İntramedüller Çivileme ve Komplikasyonları. 1. Baskı. Ankara: Türkiye Klinikleri; 2024.p.175-181

ÖZET

Avasküler nekroz (AVN), femur başının kan akışının bozulmasıyla kemik hücrelerinin ölmesi sonucu ortaya çıkar ve erken dönemde koksartroz ve kalıcı sakatlıklara neden olabilir. Etiyolojisinde çeşitli faktörler yer alır. Kemik gelişimi tamamlanmamış bireylerde femur kırıklarının intramedüller çivi- leme ile tedavisi AVN riskini artırabilir. Femur başının kanlanması medial sirkumfleks femoral arter (MCFA) gibi damarlar aracılığıyla sağlanır. İntramedüller çivileme sırasında MCFA dallarına zarar verilmesi AVN’ye yol açabilir. Piriform fossa giriş tekniği bu riski artırırken, trokanter tipinin latera- linden yapılan giriş daha güvenli bulunmuştur. Çalışmalarda, piriform girişte %2, trokanter tip girişte

%1,4 AVN oranı bildirilirken, trokanter lateral girişte AVN tespit edilmemiştir. Bu nedenle, çocuklarda güvenli giriş noktası olarak trokanter lateral giriş önerilmektedir.

Antegrad ve retrograd intramedüller çivilemede diz içi kıkırdak hasarı olduğu MR görüntüleme ile saptanmış, ancak klinik etkisi gösterilememiştir. Kadavra çalışmaları yanlış giriş noktasıyla hasarın arttığını kanıtlamıştır, bu nedenle doğru giriş yeri seçimi kritik önemdedir.

Anahtar Kelimeler: Femur başı nekrozu; Osteonekroz

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